Ustekinumab is an effective and safe treatment in patients with moderate to severe psoriasis vulgaris, with potentially higher responses observed in patients who are naïve to biologic agents and patients with a body mass index in the normal range, study data published in Dermatologic Therapy suggests.
In this retrospective follow-up study, patients with moderate to severe psoriasis vulgaris who received ≥16 weeks of treatment with only ustekinumab were followed at a single center between 2014 and 2019 (mean age, 45.8±12.3 years). Patients weighing <100 kg were treated with 45 mg subcutaneous injections of ustekinumab every 12 weeks (n=24), whereas patients weighing ≥100 kg were treated with 90 mg ustekinumab injections (n=9) every 12 weeks.
Efficacy was evaluated by a 50% reduction in the Psoriasis Area and Severity Index (PASI) score (PASI 50), a 75% reduction in PASI score (PASI 75), and a 90% reduction in PASI score (PASI 90). Researchers also assessed adverse events associated with treatment.
Prior to treatment, the mean PASI score was 13.83±6.34. By week 16, approximately 97% of patients had a PASI 50, whereas 57.6% had PASI 75 and 33.3% had PASI 90 responses. Patients who were naïve to biologic agents had generally higher PASI 50, PASI 75, and PASI 90 responses compared with a non-naive group; however, the differences were not statistically significant. In addition, generally higher responses were found in the 45-mg group vs the 90-mg group, but these responses were not significantly different in the 2 groups.
Study limitations were the small number of patients, the single-center design, and the lack of a control group.
Based on the differences in the dose groups in terms of response, the researchers wrote that “obesity may limit the response to treatment, so it is important to adjust the dose by weight to achieve the optimum effect in patients receiving biologics.”
Acer E, İğrek A, Erdoğan HK, Saracoğlu ZN. Ustekinumab in psoriasis: five-year real life experience from a single tertiary centre [published online January 9, 2020]. Dermatol Ther. doi:10.1111/dth.13224